I apologize for the delay in my comments.  I was out of town and just read
this yesterday.

On Thursday, March 8th, Pat Gima wrote:

 >>Subject: Yeast identity
 >>A mother has nipple and ductal yeast. Her baby's physician scraped the
baby's very white tongue and looked at it under a >>microscope and said
that it wasn't yeast and, therefore, will not treat for thrush.

 >>Am I mistaken in believing that yeast must be first cultured before it
will grow yeast spores and be identified under a microscope? >>If we could
identify it with just a scraping and peek, we wouldn't have so mucm sorry
for the delay in answeriestion of yeast or not >>yeast.  What say you?

 >>Pat Gima, IBCLC
 >>Milwaukee, Wisconsin

I have some expertise on this subject, as I look for yeast with a
microscope nearly every day as part of my practice as a nurse-midwife.

Yes, it is possible to see yeast with a microscope, but not easy.  It
requires bleaching out everything else by applying a drop of potassium
hydroxide, which may make the yeast visible.  Even then, it's very hard to
see, and a person who only does this occasionally may not be very skilled
at finding it.  In addition, about 30% of the time the yeast is there, but
isn't visible.  So if I see a woman with visible white (vaginal) curdy
discharge, edema, and/or itching, and even if I don't see yeast under the
microscope, I treat anyway!

By the way, I have used this technique to visualize yeast from a nipple,
but I wouldn't claim it wasn't there if I hadn't seen it!  I only do yeast
cultures for recurrent infections and/or if I think it may be an unusual
strain of yeast.  They are expensive, and it takes 4-5 days to get
results.  Mostly, I treat according to symptoms.

In my LC practice, I approached the Peds re: treating thrush by
saying:  Look, because Nystatin is such a benign drug, I can't see how we
can do any harm by treating the baby unnecesarily.  But if it is present,
the mother's sore nipples will NOT heal if we don't also treat the baby,
and that will mean the end of BF.  But if yeast is there, she'll really
thank you when her pain goes away, and you'll end up looking like a
hero.  Could we give this a try?

I hope this helps.

Janet DeCoopman MS, CNM
Milwaukee, WI

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